The U.S. Department of Justice (DOJ) reached a settlement on Tuesday with Alabama Medicaid to reverse its requirement for Medicaid recipients with Hepatitis C (HCV) to abstain from alcohol or illegal drugs to receive coverage for HCV medication.
The longstanding requirement denied coverage of HCV medication to anyone with HCV who had consumed alcohol or illicit drugs in the six months before starting treatment or while using the medication.
HCV is an infectious disease that primarily affects the liver. Though people newly affected with HCV generally have few, if any, symptoms, chronic symptoms can develop over time and even lead to liver disease or cirrhosis.
The disease typically spreads through blood-to-blood contact, such as when someone uses a dirty needle to inject heroin. It can also spread from an infected mother to her child during birth.
DOJ Assistant Attorney General Kristen Clarke said that the sobriety requirement prohibited Alabamians with substance abuse disorder from receiving equal coverage.
The DOJ settlement was secured under the Americans with Disabilities Act (ADA).
“The Justice Department is committed to enforcing the Americans with Disabilities Act to eliminate unnecessary barriers that stand in the way of equal access to health care,” Clarke said.
“We appreciate Alabama Medicaid’s willingness to work with the Department of Justice and our office to remove the sobriety restriction policy that prevented so many Alabamians with HCV, who also have substance use disorder, from receiving appropriate treatment,” said U.S. Attorney Prim F. Escalona for the Northern District of Alabama. “This settlement agreement delivers justice under the Americans with Disabilities Act and significantly advances public health in our state.”
According to the DOJ, Alabama Medicaid modified its policies and will no longer delay, deny or fail to pay for HCV treatment for Medicaid recipients based on substance use. It will also attempt to remedy any instances where the previous policy was applied.
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